The advanced lung cancer inflammation index (ALI) for risk stratification of all-cause mortality in individuals with hepatitis B virus infection: A cohort study based on NHANES.

Hepatitis B virus (HBV) infection represents a significant global health burden, with over 2 billion people affected worldwide and an increased risk of liver-related complications and mortality. Simple and effective prognostic tools are needed to stratify mortality risk in this population. This study aimed to evaluate the prognostic value of the advanced lung cancer inflammation index (ALI) for long-term mortality risk in individuals with HBV infection. This cohort study included participants with evidence of prior or current HBV infection from the National Health and Nutrition Examination Survey (1999-2018). The ALI was calculated as (body mass index × serum albumin)/neutrophil-to-lymphocyte ratio. Mortality data were linked to the National Death Index. Weighted multivariable Cox proportional hazards models and restricted cubic splines were used to assess associations between ALI and all-cause and cancer mortality, adjusting for demographic, clinical, and laboratory covariates. Among 3208 participants (representing 9194,530 US adults), 588 all-cause and 127 cancer deaths occurred. After full adjustment, a higher ALI was independently associated with a lower risk of all-cause mortality (highest vs lowest quartile: hazard ratio HR, 0.56; 95% CI, 0.40-0.79; P for trend < .001). A significant L-shaped nonlinear relationship was identified, with an inflection point at ALI = 108.34. Below this threshold, each 10-unit increase in ALI was associated with a 9.0% reduction in all-cause mortality risk (HR, 0.910; 95% CI, 0.870-0.953; P < .001). In contrast, ALI was not significantly associated with cancer mortality after multivariable adjustment (P for trend = .22). Sensitivity and subgroup analyses confirmed the robustness of the primary findings for all-cause mortality. In summary, in this nationally representative cohort of HBV-infected individuals, a lower ALI was independently associated with an increased risk of all-cause mortality in an L-shaped nonlinear pattern, with a threshold near 108. This readily accessible index may serve as a practical tool for risk stratification in this population.